Much More to Do by gjjur4356


									Volume 8, No. 4                          OCTOBER/NOVEMBER 2001                                    ISSN 1201-0383

 Much More to Do
 —Reflections on CIHI

                                  T         he Canadian health care system is struggling to meet the needs and
                                            expectations of Canadians. This struggle is not new, nor will it be
                                            decisively resolved in the near future. Better information can help
                                   in key ways.
                                        Policy-makers need better insight to allocate investment dollars among
                                   competing demands? Do we have enough imaging machines? Do we need
                                   more doctors and nurses?
                                        Managers need better information to direct finances and people in the
                                   most effective manner. Clinicians need better information to understand the
                                   myriad interactions of patients and disease. Patients need better and more
                                   information to understand their care choices and to participate in the man-
                                   agement of their own health. The Roadmap Initiative is a promising start,
                                   as is the commitment of First Ministers to provide detailed indicators.
                                        What are reasonable hopes for the future? I believe every citizen of Canada
                                   is entitled to high quality information about our health system. We deserve this
                                   information as taxpayers, as citizens and as patients and families of patients.
      Four years ago I agreed to take on the challenge of Chair of the CIHI Board. At that time, I set three
 objectives for my term as Chair. These objectives were to:
   • strengthen the Board of CIHI and the profile of the organization;
   • obtain new resources for CIHI and Statistics Canada to improve the quantity and quality of health
      information in Canada; and
   • advance CIHI as a provider of relevant information to the public.
      Great progress has been made on each of these objectives. The credit properly belongs to support from
 governments, particularly Health Canada under Federal Health Minister Allan Rock, and from the Canadian
 health care community. Our partnership with Maclean’s magazine made data come alive for the public.
 Dynamic leadership by Richard Alvarez and a talented, determined CIHI staff also contributed greatly.
      When I agreed to serve a second three-year term as Chair, I thought hard about relevant objectives. Here
 are my goals for the next three years:
   • speed up the collection and dissemination of data and improve data quality—real-time data is an ambitious
      but achievable goal in many areas;
   • secure further dollars to continue the work of CIHI and Statistics Canada in health information; and
   • tackle the patient safety issue in partnership with many others in the health community.
      I am proud of CIHI’s achievements to date. There is much, much more to be done. I hope that CIHI is
 becoming a trusted partner to all those who make decisions about health care policy and management and
 particularly by those 750,000 magnificent Canadians who rise each morning to care for those in need.

 Michael Decter
 Chair, Board of Directors
 Canadian Institute for Health Information
   Board of Directors of the
   Canadian Institute for                                Reports and Analysis
   Health Information                                    Kidney Failure on the Rise, Seniors Constitute 50% of New Patients
     Mr. Michael Decter                                       The latest statistics from CIHI show that the number of Canadian
     Lawrence Decter Investment Counsel Inc.             seniors developing kidney failure has more than doubled over the past
     (Toronto, Ontario)
                                                         10 years. According to CIHI, half of the new patients with kidney failure,
   Region 1–British Columbia and Yukon                   or end-stage renal disease, were 65 years of age or older in 1999. At 577.2
     Mr. Rick Roger
     Chief Executive Officer, Capital Health Region      per million population, this represented an increase of 132% from 1990.
     (Victoria, British Columbia)                             These figures compare with an increase of 73% in the rate of new
     Dr. Penny Ballem                                    patients with end-stage renal disease for all age groups—up from 83 per
     Deputy Minister, B.C. Ministry of Health Services   million population in 1990 to 142 per million population in 1999.
     (Victoria, British Columbia)
                                                              The majority of new end-stage renal patients (99%) initiated dialysis
   Region 2–Prairies, NWT and Nunavut                    treatment in 1999. Those patients receiving a transplant prior to starting
     Ms. Sheila Weatherill
     President and CEO, Capital Health Authority         dialysis remained low, at 1%. Among the 21,835 patients with end-stage
     (Edmonton, Alberta)
                                                         renal disease alive on December 31, 1999, 62% were on dialysis and 38%
     Dr. Brian Postl                                     had received a kidney transplant.
     Chief Executive Officer, Winnipeg Regional
     Health Authority                                         The figures are from the Canadian Organ Replacement Register (CORR),
     (Winnipeg, Manitoba)                                a national database managed by CIHI.
   Region 3–Ontario                                           The 2001 report from this database is now available and can be
     Dr. Michael Guerriere                               ordered on-line for a nominal fee from:
     Chairman and CEO, HealthLink Clinical Data
     Network Inc.
     (Toronto, Ontario)

     Mr. Daniel Burns
                                                         Slight Rise in Canada’s Physician Supply, More Specialists and
     Deputy Minister, Ministry of Health and
     Long-Term Care
                                                         Fewer Family Physicians
     (Toronto, Ontario)
                                                              A report released by CIHI this summer showed an increase of 5.3% in
   Region 4–Québec
     Mr. Terry Kaufman                                   the number of physicians in Canada over the past five years, from 54,918
     Directeur général, CLSC Notre-Dame de               in 1996 to 57,803 in 2000. This increase reflects the continued growth in
     Grâce/Montréal Ouest
     (Montréal, Québec)                                  the number of specialists in Canada (specialists now account for almost
     Ms. Kathleen Weil
                                                         half of all physicians in the country).
     Chair, Board of Directors                                From 1996 to 2000 the number of specialists increased by 7.4% while
     Régie régionale de la Santé et des Services         the national population rose by 3.5%. This resulted in an increase in the
     sociaux de Montréal Centre
     (Montréal, Québec)                                  number of specialists per capita, from 90 physicians per 100,000 population
   Region 5–Atlantic
                                                         in 1996 to 93 in 2000. Per capita rates for specialists varied widely among
     Dr. Thomas F. Ward                                  the provinces/territories, as many types of surgery are performed in larger
     Deputy Minister, Nova Scotia Department of
                                                         regional centres across the country.
     (Halifax, Nova Scotia)                                   However, CIHI’s report also noted that the number of family medicine
     Mr. Rory Francis                                    physicians has not quite kept pace with the country’s growing population.
     Deputy Minister of Health and Social Services,      While the number of family medicine physicians rose by 3.2% between
     Province of Prince Edward Island
     (Charlottetown, Prince Edward Island)               1996 and 2000, the growth in population rose by 3.5% during the same
                                                         time period. As a result, the ratio of family medicine physicians per
     Mr. Tom Closson                                     100,000 population dropped slightly, from 95 in 1996 to 94 in 2000.
     Vice-Chair of CIHI Board, President and CEO              The number of physicians per 100,000 population in Canada also
     University Health Network
     (Toronto, Ontario)                                  increased from 184 per 100,000 population in 1996 to 187 in 2000.
                                                              CIHI’s statistics also reflect the continued trend of an aging physician
     Dr. Cameron Mustard
     Scientific Director, Institute for Work & Health    workforce. In 1996, physicians under the age of 40 represented 31.6%
     (Toronto, Ontario)                                  of the total physician supply. During the same period, the proportion
   Health Canada                                         of physicians aged 50–59 years rose from 20.4% to 23.5%.
     Mr. Ian Green                                            The figures released in August are from CIHI’s publication, Supply,
     Deputy Minister of Health
     (Ottawa, Ontario)                                   Distribution and Migration of Canadian Physicians, 2000. The report is
   Statistics Canada
                                                         available for a nominal fee from CIHI’s on-line order desk:
     Dr. Ivan Fellegi                          
     Chief Statistician of Canada
     (Ottawa, Ontario)

OCTOBER/NOVEMBER 2001                                                  2                                             CIHI directions ICIS
  CIHI’s Commitment to Excellence Furthered through
  Data Quality Initiatives
  W         ith CIHI’s diverse data holdings playing an               underway for the Southam Medical Database. For new
            increasingly important role in supporting                 databases, such as the National Rehabilitation Services
            public debate and decision-making about                   and the National Ambulatory Care Reporting System,
  our health system, it is no surprise that Richard                   the framework is being applied in the development
  Alvarez, President and CEO of CIHI, places data                     of the reporting systems. All CIHI data holdings are
  quality high on the list of CIHI’s corporate priorities.            scheduled to complete the basic implementation of
                                                                      the data quality framework by July 1, 2002.
      “CIHI already has an established reputation                           In 2000, CIHI began a special data quality study of
      for producing high-quality information,” said                   the Discharge Abstract Database (DAD). This study is
      CIHI President Richard Alvarez at a recent                      being conducted on an annual basis over three years.
      presentation to all staff. “The ongoing challenge               It is aimed at reliably measuring, for the overall DAD, the
      is to build on that reputation by continually                   accuracy of approximately 50 data items. The findings
      enhancing the quality of our incoming data.”                    of the first year of the study will be released this fall
                                                                      and may be accessed through CIHI’s Web site at
       CIHI’s comprehensive data quality program            
  involves two major initiatives. The first is a recently                   The data collection for the second year of the
  adopted data quality framework designed to ensure                   study will occur from September to November of 2001.
  the quality of data by following appropriate processes              Each of these studies features a sample design that
  and procedures. The other initiative is the measurement             focuses on a set of specific health indicators. A
  and evaluation of specific data quality issues through              research paper on the methodology and the quality
  special data quality studies.                                       measurements, available in the first year of the study,
       CIHI has developed a Data Quality Manual to                    was presented at the Statistics Sweden International
  serve as an internal working tool for CIHI database                 Conference on Quality and Official Statistics, in May
  analysts and managers. The manual will allow CIHI staff             2001. The results and the knowledge gained from the
  to analyze and document the data quality dimensions                 first year of the study will be discussed in a research
  (and their specific characteristics) of accuracy, timeliness,       paper to be presented in October 2001 at Statistics
  usability, relevance and comparability. Two-day data                Canada’s International Symposium on Achieving Data
  quality training workshops for staff are held on an on-             Quality Within a Statistical Agency.
  going annual basis. CIHI’s approach to implementing                        CIHI is committed to ensuring quality data. This
  its data quality framework will be presented in various             means that the data must be timely and accurate.
  forums at the Massachusetts Institute of Technology                 Policy-makers, leaders in the health care sector and
  Information Quality Conference in November 2001.                    the public must be afforded the opportunity to make
       While many elements of the data quality frame-                 sound decisions based on sound available data. The
  work have been in place for some time, it is now being              ongoing development of initiatives to enhance data
  implemented systematically across all data systems. For             quality is an important part of CIHI’s work.
  example, the Registered Nurses Database and the Annual
  Hospital Survey have completed their implementation
  of the framework and will be initiating special studies
  to further improve accuracy. The implementation is

  For more information please contact:
  Ann Brown, Senior Methodologist
  Data Quality
  Tel: (613) 241-7860 ext. 4131
  Fax: (613) 241-8120

OCTOBER/NOVEMBER 2001                                             3                                             CIHI directions ICIS
       Canadian Joint Replacement Registry
       Improving Patient Outcomes

       S    ince May 2001, surgeons from across the country
            have been submitting data to the Canadian Joint
            Replacement Registry (CJRR). The CJRR is a new
       national registry that captures information on total hip
       and knee replacement surgery performed in Canada.
            The registry is designed to monitor patient out-
       comes following surgery, including revision rates. It is
       anticipated that outcomes will eventually be improved
       using data from the registry. CIHI manages the CJRR
       and partners with the orthopedic surgeons of Canada
       on the development and implementation of this project.
            Once patient consent is obtained, data are
       collected by orthopedic surgeons and their staff (except
       in Ontario) and submitted directly to CIHI where data
       checks and data entry are completed. CIHI has been
       working closely with the Ontario Joint Replacement
       Registry (OJRR) to facilitate electronic submission of
                                                                                                           Source: Swedish Hip Arthroplasty Register
       data directly for Ontario surgeons from the OJRR.
            CIHI data reveal an increasing number of total hip
       and knee replacements since 1994–95. This is due to                As demonstrated in Sweden, joint replacement
       an aging population and a rising number of younger            surgery can be improved to decrease revision rates
       active Canadians who are receiving replacements.              through evidence-based practice. Sweden has one of
       Estimates indicate that 10–12% of all total hip and           the oldest national joint replacement registries in the
       knee replacement patients need subsequent replace-            world. The operative data elements of CJRR hold the
       ments (i.e. revisions) due to implant wear and breakage.      key to improving outcomes for hip and knee replace-
       Summary CJRR data is shown in the figures below.              ment surgery patients. For example, CJRR data will be
                                                                     used to measure and compare the post-market perform-
                                                                     ance of the implants used in these operations.
         Number of total hip and knee replacements by year                The first annual CJRR report will be produced
         Canada, 1994–1995 to 1999–2000                              in January 2002 and will focus on total hip and knee
24,000                                                               replacement procedures in Canada using data from CIHI’s
                                                                     Discharge Abstract Database and Hospital Morbidity
                                                                     Database. Later in 2002, CIHI will also release its first
20,000                                                               report based on the operative data collected for CJRR.
                                                                          The CJRR team is committed to ensuring that the
                                                                     registry is comprehensive and an important tool for
16,000                                                               evidence-based decision-making. The CJRR team is
                                                                     examining the feasibility of adding new data elements
                                                                     to CJRR, including wait-times, prioritization and illness
                                                                     severity, and patient functioning. Efforts are underway
                                                                     to leverage technology in the collection of all CJRR data.
         1994/95   1995/96   1996/97   1997/98   1998/99   1999/00
                                                                     The registry holds enormous potential for revealing
Hip       16,787    17,854    17,823    18,141    18,764    20,036   essential information that will impact on the future
Knee      15,360    17,344    18,606    19,709    20,532    22,302
                                                                     health of Canadians.

                                                                     For more information please contact:
           The CJRR has started collecting detailed operative        Kinga David, Senior Analyst
       data on patient care and outcomes including the               Canadian Joint Replacement Registry
       reasons for revisions and the actual revision rate,           Tel: (416) 481-2002 ext. 3592
       which cannot be determined from existing data.                Fax: (416) 481-2950

OCTOBER/NOVEMBER 2001                                                4                                                  CIHI directions ICIS
   CPHI Takes a Global Perspective

    A       lthough policy analysis and          In addition to creating a                As a knowledge broker, CPHI
            knowledge transfer have         Policy Sub-Committee, the CPHI           is tackling these issues by asking,
            always been a fundamental       Council has established criteria to      “What is known about effective
    element of the Canadian Population      select issues for policy analysis        policies/solutions? What has worked?
    Health Initiative’s mandate (CPHI),     and knowledge transfer that              What hasn’t worked? and Why?”
    CPHI is now rising to the challenge     emerge from CPHI funded                  These questions will be answered
    of synthesizing population health       research and other research out-         through synthesis of research
    research results from around the        side Canada. The criteria include:       findings and policy research that
    world. This bringing together of         • a strong evidence base;               includes a review of policies and
    information is being accomplished        • issues that touch more than one       programs that have been tried
    by establishing links between              sector (e.g. environment, health,     around the world. The results will
    researchers and policy makers and          economic etc.), resonating with       be published in discussion papers.
    transforming new knowledge into            a variety of policy areas;            Over the coming months, the
    forms that are useful to policy and      • problems that are amenable to         papers will form the basis for
    decision-makers as well as inform-         change; and                           round table discussions where key
    ative to the Canadian public.            • apparent potential for gains in       policy and decision-makers at all
         Since its inception in 1998,          health.                               levels will have the opportunity to
    CPHI has distinguished itself by sup-        When CPHI applied these cri-        advance our understanding about
    porting innovative population health    teria to recent population health        the issues and identify policy
    research and data infrastructure        research findings and emerging           options.
    development. It has established a       policy issues, three priority themes
    strong Canadian presence in pop-        surfaced: obesity, family poverty        For more information, contact:
                                            and Aboriginal health. All three         Joan Campbell, Manager
    ulation health knowledge generation
                                            involve issues that have strong          CPHI Policy Analysis
    through the commitment of more                                                   Tel: (613) 241-7860 ext. 4173
    than $6.1 million dollars on research   resonance with policy and
                                                                                     Fax: (613) 241-8120
    on the determinants of health, and      decision-makers. Yet despite             E-mail:
    the support of 25 multidisciplinary     mounting evidence, there seem to
    teams of researchers in a               be more questions than answers
    pan-Canadian network.                   about solutions to these problems.

    New Approach to Promoting Use of CIHI National Trauma
    Registry Data
         A new approach to promoting        Committee members were sent              confidentiality guidelines were
    the use of CIHI’s National Trauma       notices of this offering.                considered.
    Registry (NTR) was introduced this           The strategy allowed
    past summer. The specific goal was      researchers who were intending to        For further information please
    to increase the number of               prepare abstracts for the confer-        contact:
    researchers using NTR data to           ence, to obtain without charge,          Julian Martalog, Consultant
                                                                                     National Trauma Registry
    develop abstracts for the 6th World     aggregate level data tables based on     Tel: (613) 241-7860 ext. 3408
    Conference on Injury Prevention         the National Trauma Registry data-       Fax: (613) 241-8120
    and Control, being held in May          bases. As always, only those data        E-mail:
    2002, in Montreal. NTR Advisory         tables meeting CIHI’s privacy and

   Call for Nominations – Joady Murray Award
         To honour the life and work of Joady Murray, the Canadian Institute for Health Information (CIHI) and the Canadian
    Health Record Association (CHRA) established an award to recognize a CHRA member who is pursuing continuing studies in
    health information management. Nominations must be submitted to the CHRA by December 31st, 2001. More information about
    the award and the nomination form can be found at:

OCTOBER/NOVEMBER 2001                                         5                                              CIHI directions ICIS
   MIS Introductory Courses Available On-line
   CIHI is entering the world of e-Learning. The                       These courses consist of an introduction to CIHI
                                                                  and seven modules in addition to a User Guide, a
   first of what is expected to be several courses is now         Course Map and References. Each module is followed
   available through the CIHI Web site. Previously, clients       by an exercise consisting of multiple-choice questions
   were required to wait for a workshop or the release of         in order to confirm learning. Immediate feedback is
   a paper-based self-learning product. Now with the              provided for the end-of-module exercises. The course
   introduction of Web-based education, training products         concludes with the participants completing the on-line
   can be accessed on a 24/7 basis at work or at home.            final test. Upon completion participants are immediately
        Distance learning has long been a method for pro-         presented with their score, the correct answers and an
   viding education and training for students who are             explanation for those answers. This provides further
   unable to attend formal classes. Early distance courses        reinforcement of the principle teaching points. Having
   used paper-based, disc                                         successfully achieved a passing grade on the test, a
   or CD-ROM course                                                                  certificate of completion is issued.
   material. These were                                                                                    Following the
   accompanied by assign-                                                                             launch of CIHI’s
   ments and exams that                                                                               inaugural e-Learning
   were sent back and                                                                                initiative, work will
   forth between the stu-                                                                            begin on identifying
   dent and the learning                                                                             other education prod-
   institution. With the                                                                             ucts that lend them-
   advent of the World                                                                              selves to conversion to
   Wide Web,                                                                                        the Web. Courses to
   education/training has                                                                           support the National
   become readily avail-                                                                            Ambulatory Care
   able to anyone with                                                                             Reporting System,
   a computer and Web                                                                              ICD-10-CA/CCI, Grouping
   access allowing                                                                                Methodology and others
   participants to have                                                                           will be carefully examined
   immediate interaction                                                                          as to their feasibility for
   and feedback.                                                                                 conversion to the
        CIHI’s first e-                                                                          e-Learning environment.
   Learning courses were previously                                                              Watch for them, as well as
   offered as paper-based self-learning packages. Now                                            other learning initiatives,
   the Management Information System (MIS) Guidelines             to follow in the coming months.
   introductory courses (Acute Care and Community                      Access to the on-line courses is through the CIHI
   Health Service Organizations) are available as interac-        Web site, Click on e-Order/Registration
   tive Web-based products. The courses are asynchro-             Desk, then Education. Under Products click on
   nous, meaning participants can work in their own               Management Information System, then Introduction to
   time, according to their own schedule and from any             the MIS Guidelines–E-Learning and follow the steps to
   computer with Web access.                                      register for the course.

  For further information please contact:
  Stephen Olsen, Consultant
  Tel: (613) 241-7860 ext. 4111
  Fax: (613) 789-2114

OCTOBER/NOVEMBER 2001                                         6                                               CIHI directions ICIS
   CIHI’s Role in International                         NACRS – Expanding into Ontario
   Classification of Functioning,                       and British Columbia
   Disability and Health
                                                        I   n July 2000, the Ontario Ministry of Health mandated
                                                            the collection of National Ambulatory Care Reporting
                                                            System (NACRS) data for all hospital emergency depart-

   T       he World Health Organization (WHO)
           released the International Classification
           of Impairments, Disability and Handicaps
   (ICIDH) in 1980. It then underwent extensive
   field trials, testing and comment throughout the
                                                        ments and urgent care centres in Ontario.
                                                             In June 2001, North Okanagan Region in British
                                                        Columbia also agreed to begin data collection using NACRS,
                                                        effective this fall, joining Prince Rupert Hospital that served
   world. As a member of the North American             as CIHI’s first adopting facility of NACRS in British Columbia
   Collaborating Centre (NACC), CIHI coordinated        four years earlier. Further efforts towards encouraging a
   the Canadian input into the mandatory WHO            national adoption of NACRS have included information
   field trials and revision process. A number of       exchange sessions held in Vancouver and Nova Scotia
   centre-specific tests that were considered high      (for all Atlantic Provinces).
   priority for Canadian users and applications              Ambulatory medical care is increasingly becoming the
   were also conducted with extensive input from        predominant method of providing health care services in
   stakeholder individuals and organizations.           North America and occurs in a wide range of settings.
        In May 2001, WHO approved the successor         Information on hospital emergency departments and out-
   of ICIDH, the International Classification of        patient care settings has been lacking for a number of
   Functioning, Disability and Health (ICF). ICF is     years. Commitment to supporting the collection and
   a classification that deals with functional states   analysis of ambulatory care information will in turn lead
   associated with health conditions at the body,       to more effective planning and decision-making in the
   individual and societal levels. It provides a        delivery of services.
   standard language and framework for the                   CIHI’s National Ambulatory Care Reporting System is
   description of human functioning and disability      designed to collect all ambulatory activity in facilities regions
   as components of health.                             and communities. It is capable of including emergency, day
        ICF complements the International               surgery and clinic encounters.
   Classification of Diseases ICD. While taking a            In Ontario, for the period of July 2000 to March 2001,
   neutral stand on etiology, ICF opens research        a total of 3,029,898 records were submitted to NACRS. One
   opportunities to explore causal factors and out-     hundred and fifty (90%) of the 167 hospital emergency
   comes. It is anticipated that ICF will advance       departments and urgent care centres identified for inclusion
   new opportunities for rehabilitation, research,      in NACRS successfully submitted information. Over the nine-
   teaching and clinical work.                          month period, 83% of the expected data was submitted
        ICF includes the domains of Activities          to CIHI successfully by hospitals. Seventeen hospital sites
   (execution of a task by an individual) and           (10%) or 13 corporations did not submit data for fiscal
   Participation (involvement in a life situation)      year 2001–02 although six sites did submit test data.
   under one list. There is the option within ICF            Following the application of CIHI’s data quality frame-
   to “split” the list of Activities (A) and            work, CIHI is working towards providing hospitals with
   Participation (P) according to needs and pro-        comparative NACRS data for use by fall, 2001. These data
   posed uses. In May 2001, CIHI coordinated a          are intended to help in the evaluation and planning of
   project, with support from the National Center       ambulatory care service delivery.
   for Health Statistics, Center for Disease Control,        NACRS is an innovative project that reflects the infor-
   MD, US, to develop a proposal for mutually           mation needs of policy and decision-makers and is respon-
   exclusive lists of A and P in ICF to clarify the     sive to the direction of health care delivery in Canada.
   distinction and reduce overlap.
                                                        For further information please contact:
                                                        Paula Freedman, Coordinator
                             continued on page 8        NACRS
                                                        Tel: (416) 481-2002 ext. 3442
                                                        Fax: (416) 481-2950

OCTOBER/NOVEMBER 2001                                    7                                                CIHI directions ICIS
    continued from page 7

         The proposal offers three options
    to separate them and a valuable first
    step in defining a centre-specific
    version of ICF with distinct lists
    of A and P that Canada, the US and
    perhaps other centres will find useful.
         This proposal was presented at a
    meeting sponsored by the WHO
    Collaborating Center for the                                               Get Current Health
    Classification of Diseases for North
    America in New York, on June 7, 2001.                                  Information through CIHI’s
         The next steps in Canada will
    include a review of this proposal by
                                                                               On-line Order Desk
    the CIHI National Expert Working
    Group and other key stakeholders to
    achieve consensus on a country-                                          CIHI’s on-line order desk allows you to take
    specific version of Activities and                                     care of business from the comfort of your own
    Participation that can be used for                                     office. You can register for a workshop or order
    statistical data collection, policy                                     one of our newest publications/reports. If you
    development, and other aggregate                                         order an electronic copy of a publication or
    needs.                                                                        report, you benefit from a discount.
    For more information please contact:
    Diane Caulfeild, CIHI Consultant                                                       For more information,
    Classification                                                                          visit our Web site at:
    Tel: (613) 241-7860 ext. 4055
    Fax: (613) 241-8120

                                                                   B E T T E R H E A LT H I N F O R M AT I O N F O R B E T T E R H E A LT H

                                                   CIHI         directions              ICIS
     CIHI directions ICIS is published quarterly by the Canadian               Managing Editor: Serge Taillon
     Institute for Health Information (CIHI). Since 1994, this national,       Editor: Sylvia Ralphs-Thibodeau
     independent, not-for-profit organization has been working to              Contributors: Ann Brown, Joan Campbell, Diane Caulfeild,
     improve the health of Canadians and the health care system by             Kinga David, Mr. Michael Decter, Nizar Ladak, Karen
     providing quality health information.                                     McCarthy, Stephen Olsen, Laura Sato, Greg Webster. For
            The Institute’s mandate is to coordinate the development           comments, questions or additional copies of this publication,
     and maintenance of a comprehensive and integrated                         in English or French please contact the Editor at:
     approach to health information for Canada. To this end,
     CIHI provides and coordinates accurate and timely data and                             Editor, CIHI directions
     information required to establish sound health policies,                               200-377 Dalhousie St.
     effectively manage the Canadian health system and gener-                               Ottawa, Ont. K1N 9N8
     ate public awareness about factors affecting good health.                              Tel: (613) 241-7860
            Contents of this publication may be reproduced in whole                         Fax: (613) 241-8120
     or in part provided that the intended use is for non-commer-                           E-mail:
     cial purposes and full acknowledgement is given to the                                 Web site:
     Canadian Institute for Health Information.
                                              Cette publication est également disponible en français.

OCTOBER/NOVEMBER 2001                                                      8                                                  CIHI directions ICIS

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